Alcohol misuse: tackling the UK epidemic - London

Although the UK government is responsible for setting the overall drug strategy, each devolved
administration exercises its delegated powers to shape the strategy to address local circumstances. The
Scottish Executive set out its drugs strategy in Tackling drugs in Scotland: action in partnership and in 2000
Wales launched Tackling substance misuse in Wales: a partnership approach.
Evaluating the effectiveness of interventions in adolescent smoking,
drinking and drug use
Many risk taking behaviours such as binge drinking and drug use, peak during adolescence and early
adulthood. Most adolescent use of recreational drugs is limited to a particular phase in a young person’s
life before work and family responsibilities take over. Evidence suggests that the main limiting factor of
these behaviours is change in circumstance. 79
Nevertheless, the risk taking behaviours of adolescents are
of concern to the government. Effective intervention would improve adolescents’ current and future
health and may prevent the development of addiction. This section reviews some of the most common
types of intervention in adolescent smoking, drinking and drug use.
Limiting the availability of cigarettes, alcohol and drugs
Controlling access to cigarettes is a well established strategy in attempts to prevent adolescents from
becoming addicted to tobacco. This forms part of the government’s strategy set out in the white paper
Smoking kills to reduce the prevalence of smoking among young people. The government is also hoping to
reduce drinking among adolescents by enforcing the law on under age drinking. In drugs policy too,
limiting the supply of illegal substances has consistently represented an important strand of the
government’s tactics. 78
There are two main strategies for limiting the access of adolescents to cigarettes and alcohol. Firstly, the
government can enforce existing age restrictions on the purchase of these commodities in the hope that this
will decrease their physical availability, secondly, it can choose to increase the price of tobacco and alcohol
products thereby reducing their economic availability. In the case of drugs, the government can attempt to
reduce both the physical and economic availability to adolescents by decreasing supply in the UK.
A reduction in the availability of illegal substances in the UK as a whole would reduce their use among
adolescents. However, the efficacy of efforts to reduce the availability of cigarettes and alcohol for a specific
age group is debatable. There is ample evidence that the great majority of young smokers have little or no
difficulty purchasing cigarettes from a variety of retail outlets. 68
Enforcement of licensing laws can have an
effect on retailer behaviour but it is less clear whether these measures are likely to have much impact on
adolescent behaviour. 104
The Schools Health Education Unit found that, in 2001, 14 and 15 year olds were
less likely to buy cigarettes from a shop than in previous years. As this activity is illegal for the under-16s,
the downward trend suggests that attempts to dissuade young people from buying cigarettes from shops
may be working. 65
However, there are many potential sources of cigarettes for adolescent smokers
including parents, friends and vending machines. 105
A survey of drinking behaviour among 11 to 15 year
olds in 2000 found that 49 per cent of pupils who have ever had a drink never buy alcohol. Purchasing
from off-licenses (17% in 2000) or shops/supermarkets (9%) has become markedly less common since
1996, whereas increasing numbers have been purchasing from friends or relatives (17%). 98
Increasing the cost of cigarettes and alcohol may be a more effective method of reducing their use by
adolescents. The evidence that tax and price increases reduce alcohol-related harm is stronger than that
for the efficacy of educational measures. 106
Increasing the price of cigarettes quickly and sharply has also
been suggested as a potentially effective area for policy change to impact upon adolescent tobacco use. 107
Smoking habits among adolescents have been found to be driven by the availability of both cigarettes and
money. One study found youth, minorities and low-income smokers to be two to three times more likely
to stop smoking than other smokers in response to price increases. 108
However, while a packet of cigarettes
can be perceived as expensive, adolescents do not necessarily consider individual cigarettes themselves to
British Medical Association Adolescent health 21